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1.
ERJ Open Res ; 9(6)2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38020572

RESUMO

Background: Immersive virtual reality (iVR)-based digital therapeutics are gaining clinical attention in the field of pain management. Based on known analogies between pain and dyspnoea, we investigated the effects of visual respiratory feedback on persistent dyspnoea in patients recovering from coronavirus disease 2019 (COVID-19) pneumonia. Methods: We performed a controlled, randomised, single-blind, crossover proof-of-concept study (feasibility and initial clinical efficacy) to evaluate an iVR-based intervention to alleviate dyspnoea in patients recovering from COVID-19 pneumonia. Included patients reported persistent dyspnoea (≥5 on a 10-point scale) and preserved cognitive function (Montreal Cognitive Assessment score >24). Assignment was random and concealed. Patients received synchronous (intervention) or asynchronous (control) feedback of their breathing, embodied via a gender-matched virtual body. The virtual body flashed in a waxing and waning visual effect that could be synchronous or asynchronous to the patient's respiratory movements. Outcomes were assessed using questionnaires and breathing recordings. Results: Study enrolment was open between November 2020 and April 2021. 26 patients were enrolled (27% women; median age 55 years, interquartile range (IQR) 18 years). Data were available for 24 of 26 patients. The median rating on a 7-point Likert scale of breathing comfort improved from 1 (IQR 2) at baseline to 2 (IQR 1) for synchronous feedback, but remained unchanged at 1 (IQR 1.5) for asynchronous feedback (p<0.05 between iVR conditions). Moreover, 91.2% of all patients were satisfied with the intervention (p<0.0001) and 66.7% perceived it as beneficial for their breathing (p<0.05). Conclusion: Our iVR-based digital therapy presents a feasible and safe respiratory rehabilitation tool that improves breathing comfort in patients recovering from COVID-19 infection presenting with persistent dyspnoea. Future research should investigate the intervention's generalisability to persistent dyspnoea with other aetiologies and its potential for preventing chronification.

2.
Vaccines (Basel) ; 11(8)2023 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-37631852

RESUMO

Immunocompromised patients (ICPs) have a higher risk of developing severe forms of COVID-19 and experience a higher burden of complications and mortality than the general population. However, recent studies have suggested that the antibody response to SARS-CoV-2 mRNA vaccines could be highly variable among different ICPs. Using a collaborative, monocentric, prospective cohort study, we assessed anti-SARS-CoV-2 spike protein antibody titers following two and three doses of mRNA vaccines in four groups of ICPs (cancer [n = 232]: hematopoietic stem cell transplant [HSCT; n = 126] patients; people living with HIV [PLWH; n = 131]; and lung transplant [LT; n = 39] recipients) treated at Geneva University Hospitals; and healthy individuals (n = 49). After primo-vaccination, the highest anti-S antibody geometric mean titer (IU/mL) was observed in healthy individuals (2417 IU/mL [95% CI: 2327-2500]), the PLWH group (2024 IU/mL [95% CI:1854-2209]) and patients with cancer (840 IU/mL [95% CI: 625-1129]), whereas patients in the HSCT and LT groups had weaker antibody responses (198 IU/mL [95% CI: 108-361] and 7.3 IU/mL [95% CI: 2.5-22]). The booster dose conferred a high antibody response after 1 month in both PLWH (2500 IU/mL) and cancer patients (2386 IU/mL [95% CI: 2182-2500]), a moderate response in HSCT patients (521 IU/mL [95% CI: 306-885]) and a poor response in LT recipients (84 IU/mL [95% CI: 18-389]). Contemporary treatment with immunosuppressive drugs used in transplantation or chemotherapy was associated with a poor response to vaccination. Our findings confirmed the heterogeneity of the humoral response after mRNA vaccines among different ICPs and the need for personalized recommendations for each of these different groups.

3.
BMJ Open Respir Res ; 9(1)2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35459694

RESUMO

BACKGROUND: The Clinical Frailty Scale (CFS) is increasingly used for clinical decision making in acute care but little is known about frailty after COVID-19. OBJECTIVES: To investigate frailty and the CFS for post-COVID-19 follow-up. METHODS: This prospective multicentre cohort study included COVID-19 survivors aged ≥50 years presenting for a follow-up visit ≥3 months after the acute illness. Nine centres retrospectively collected pre-COVID-19 CFS and prospectively CFS at follow-up. Three centres completed the Frailty Index (FI), the short physical performance battery (SPPB), 30 s sit-to-stand test and handgrip strength measurements. Mixed effect logistic regression models accounting for repeated measurements and potential confounders were used to investigate factors associated with post-COVID-19 CFS. Criterion and construct validity were determined by correlating the CFS to other concurrently assessed frailty measurements and measures of respiratory impairment, respectively. RESULTS: Of the 288 participants 65% were men, mean (SD) age was 65.1 (9) years. Median (IQR) CFS at follow-up was 3 (2-3), 21% were vulnerable or frail (CFS ≥4). The CFS was responsive to change, correlated with the FI (r=0.69, p<0.001), the SPPB score (r=-0.48, p<0.001) (criterion validity) and with the St George's Respiratory Questionnaire score (r=0.59, p<0.001), forced vital capacity %-predicted (r=-0.25, p<0.001), 6 min walk distance (r=-0.39, p<0.001) and modified Medical Research Council (mMRC) (r=0.59, p<0.001). Dyspnoea was significantly associated with a higher odds for vulnerability/frailty (per one mMRC adjusted OR 2.01 (95% CI 1.13 to 3.58), p=0.02). CONCLUSIONS: The CFS significantly increases with COVID-19, and dyspnoea is an important risk factor for post-COVID-19 frailty and should be addressed thoroughly.


Assuntos
COVID-19 , Fragilidade , Estudos de Coortes , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Força da Mão , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos
4.
PLoS One ; 16(8): e0256230, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383866

RESUMO

BACKGROUND: The symptomatic response to continuous positive airway pressure (CPAP) therapy in COPD-obstructive sleep apnea overlap syndrome (OVS) compared to OSA syndrome (OSA) alone has not been well studied so far. The aim of this study is to explore main differences in the clinical response to CPAP treatment in OVS compared to OSA alone. STUDY DESIGN AND METHODS: Using prospective data from the French National Sleep Apnea Registry, we conducted an observational study among 6320 patients with moderate-to-severe OSA, available spirometry, and at least one follow-up visit under CPAP therapy. RESULTS: CPAP efficacy measured on the residual apnea-hypopnea index and median adherence were similar between OVS and OSA patients. In both groups, the overall burden of symptoms related to sleep apnea improved with CPAP treatment. In a multivariable model adjusted for age, gender, body mass index, adherence to treatment and residual apnea-hypopnea index, OVS was associated with higher odds for persistent morning headaches (OR: 1.37 [95% CI; 1.04; 1.79]; P = 0.02), morning tiredness (OR: 1.33 [95% CI: 1.12; 1.59]; P<0.01), daytime sleepiness (OR; 1.24 [95% CI: 1.4; 1.46]: P<0.01) and exertional dyspnea (OR: 1.26 [95% CI: 1.00;1.58]; P = 0.04) when compared with OSA alone. INTERPRETATION: CPAP therapy was effective in normalizing the apnea-hypopnea index and significantly improved OSA-related symptoms, regardless of COPD status. CPAP should be offered to patients with OVS on a trial basis as a significant improvement in OSA-related symptoms can be expected, although the range of response may be less dramatic than in OSA alone.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas/métodos , Distúrbios do Sono por Sonolência Excessiva/prevenção & controle , Fadiga/prevenção & controle , Doença Pulmonar Obstrutiva Crônica/terapia , Sistema de Registros , Síndromes da Apneia do Sono/terapia , Distúrbios do Sono por Sonolência Excessiva/fisiopatologia , Fadiga/fisiopatologia , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente , Estudos Prospectivos , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Índice de Gravidade de Doença , Síndromes da Apneia do Sono/fisiopatologia , Espirometria
5.
PLoS One ; 15(7): e0235331, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645005

RESUMO

BACKGROUND: More advanced knowledge is needed on how COPD alters the clinical presentation of obstructive sleep apnea (OSA) and how the association of both diseases, known as 'overlap syndrome' (OVS), impacts on cardiovascular health. OBJECTIVE: To investigate differences between patients with OVS and those with moderate-to-severe OSA alone. METHODS: A cross-sectional study conducted in the French National Sleep Apnea Registry between January 1997 and January 2017. Univariable and multivariable logistic regression models were used to compare OVS versus OSA alone on symptoms and cardiovascular health. RESULTS: 46,786 patients had moderate-to-severe OSA. Valid spirometry was available for 16,466 patients: 14,368 (87%) had moderate-to-severe OSA alone and 2098 (13%) had OVS. A lower proportion of OVS patients complained of snoring, morning headaches and excessive daytime sleepiness compared to OSA alone (median Epworth Sleepiness Scale score: 9 [interquartile range (IQR) 6-13] versus 10 (IQR 6-13), respectively; P <0.02). Similarly, a lower proportion of OVS patients (35.6% versus 39.4%, respectively; P <0.01) experienced sleepiness while driving. In contrast, 63.5% of the OVS population experienced nocturia compared to 58.0% of the OSA population (P<0.01). Apnea hypopnea index (36 [25; 52] vs 33.1 [23.3; 50]), oxygen desaturation index (28 [15; 48] vs 25.2 [14; 45]) and mean nocturnal SaO2 (92 [90; 93.8] vs 93 [91.3; 94]) were significantly more altered in the OVS group. Associated COPD had no effect on the prevalence of hypertension and stroke. After controlling for main confounders, COPD severity was associated in a dose-response relationship with a higher prevalence of coronary heart disease, heart failure and peripheral arteriopathy. CONCLUSIONS: In adults with moderate-to-severe OSA, OVS was minimally symptomatic, but exhibited higher odds for prevalent coronary heart disease, heart failure and peripheral arteriopathy.


Assuntos
Doença Pulmonar Obstrutiva Crônica/epidemiologia , Síndromes da Apneia do Sono/epidemiologia , Doenças Cardiovasculares/complicações , Comorbidade , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Análise Multivariada
6.
Rev Med Suisse ; 4(180): 2525-6, 2528-30, 2008 Nov 19.
Artigo em Francês | MEDLINE | ID: mdl-19127897

RESUMO

Pneumocystis jirovecii is an opportunistic pathogen causing life-threatening pneumonia in immunosuppressed patients. The number of non-HIV immunosuppressed patients at risk for Pneumocystis pneumonia is rapidly growing. In contrast to HIV patients, there are no guidelines for Pneumocystis prophylaxis in other immunocompromised hosts. A detailed analysis of current literature data allowed us hereby to define the type of immunocompromised patients for whom evidence suggests a benefit for PCP prophylaxis.


Assuntos
Anti-Infecciosos/administração & dosagem , Infecções por HIV , Hospedeiro Imunocomprometido , Pneumocystis carinii , Pneumonia por Pneumocystis/prevenção & controle , Combinação Trimetoprima e Sulfametoxazol/administração & dosagem , Doenças do Tecido Conjuntivo/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Medicina Baseada em Evidências , Humanos , Neoplasias/complicações , Guias de Prática Clínica como Assunto , Desnutrição Proteico-Calórica/complicações , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Transplante/efeitos adversos , Resultado do Tratamento , Vasculite/complicações
7.
Rev Med Suisse ; 4(180): 2532-5, 2008 Nov 19.
Artigo em Francês | MEDLINE | ID: mdl-19127898

RESUMO

Since most patients with cystic fibrosis (CF) die from respiratory failure, lung transplantation remains for many of them the ultimate treatment. The decision to put a patient on the transplantation waiting list is based on a list of criteria from international guidelines. We aimed to determine if a survival score could help determine when a CF patient has to be referred to a transplantation program. We applied this score to a small number of consecutive patients from our adult CF clinic, but found that it was of limited value for individual decision. Awareness of international guidelines and clinical judgement are essential to refer CF patients at proper time for lung transplantation.


Assuntos
Fibrose Cística/cirurgia , Transplante de Pulmão , Seleção de Pacientes , Encaminhamento e Consulta , Fibrose Cística/complicações , Fibrose Cística/mortalidade , Volume Expiratório Forçado , Hemoptise/etiologia , Humanos , Hipercapnia/etiologia , Hipertensão Pulmonar/etiologia , Pneumotórax/etiologia , Guias de Prática Clínica como Assunto , Prognóstico , Insuficiência Respiratória/etiologia , Fatores de Risco , Análise de Sobrevida , Listas de Espera
8.
Front Biosci ; 11: 1289-301, 2006 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-16368516

RESUMO

Matrix metalloproteinases (MMPs) are involved in the pathogenesis of several diseases of the CNS, that share common pathophysiological processes, such as blood-brain barrier (BBB) disruption, oxidative stress, remodeling of the extracellular matrix (ECM) and inflammation. In ischemic brain injury, MMPs are implicated in various stages of the disease. Early after the onset of ischemia, MMPs contribute to the disruption of the BBB leading to vasogenic edema and to the influx of leucocytes into the CNS. The ability of MMPs to digest the basal lamina of capillaries increases the risk of hemorrhagic transformation of the ischemic tissue. During the acute ischemic phase, maintenance of the ECM is essential for neuronal survival. However, ECM degradation and its reconstitution are critical to tissue recovery. MMPs as a key modulator of ECM homeostasis play a role in the cascades leading to neuronal cell death and tissue regeneration. This pleiotropic implication of MMPs in brain injury has open new areas of investigation, which should lead to innovative therapeutic strategies. Yet MMPs may have a detrimental or beneficial role depending on the stage of brain injury. Simple therapeutic strategies based on MMP inhibition have thus little chance to favorably alter prognosis.


Assuntos
Isquemia Encefálica/patologia , Metaloproteinases da Matriz/fisiologia , Animais , Apoptose , Barreira Hematoencefálica/patologia , Encéfalo/patologia , Lesões Encefálicas/patologia , Capilares , Catálise , Sobrevivência Celular , Sistema Nervoso Central/patologia , Doenças do Sistema Nervoso Central/patologia , Matriz Extracelular/metabolismo , Homeostase , Humanos , Inflamação , Isquemia/patologia , Metaloproteinases da Matriz/metabolismo , Meningites Bacterianas/patologia , Esclerose Múltipla/patologia , Neurônios/metabolismo , Neurônios/patologia , Estresse Oxidativo , Prognóstico
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